Impact of LAB from Serpa PDO Cheese in Cheese Models: Towards the Development of an Autochthonous Starter Culture.

Serpa is a protected designation of origin (PDO) cheese produced with raw ewes' milk and coagulated with Cynara cardunculus. Legislation does not allow for milk pasteurization and starter culture inoculation. Although natural Serpa's rich microbiota allows for the development of a unique organoleptic profile, it also suggests high heterogeneity. This raises issues in the final sensory and safety properties, leading to several losses in the sector. A possible solution to overcoming these issues is the development of an autochthonous starter culture. In the present work, some Serpa cheese Lactic acid bacteria (LAB)-isolated microorganisms, previously selected based on their safety, technological and protective performance, were tested in laboratory-scale cheeses. Their acidification, proteolysis (protein and peptide profile, nitrogen fractions, free amino acids (FAA)), and volatiles generation (volatile fatty acids (VFA) and esters) potential was investigated. Significant differences were found in all parameters analyzed, showing a considerable strain effect. Successive statistical analyses were performed to compare cheese models and Serpa PDO cheese. The strains L. plantarum PL1 and PL2 and the PL1 and L. paracasei PC mix were selected as the most promising, resulting in a closer lipolytic and proteolytic profile of Serpa PDO cheese. In future work, these inocula will be produced at a pilot scale and tested at the cheese level to validate their application.

Dental care for patients with special needs at a private higher education institute / Atendimento odontológico a pacientes com necessidades especiais em uma instituição privada de ensino superior

Objetivo: Pacientes com necessidades especiais são aqueles indivíduos que necessitam de cuidados especiais por tempo indeterminado ou por toda a vida. O presente estudo tem como objetivo abordar o atendimento odontológico de pacientes com necessidades especiais em uma instituição privada de ensino superior da cidade de São Paulo. Material e Métodos: Foi realizado um estudo descritivo, retrospectivo, para análise de 210 prontuários odontológicos de pacientes com necessidades especiais atendidos no Departamento de Odontologia para Pacientes Especiais da Universidade Cruzeiro do Sul entre 2012 e 2018. Dados sobre sexo, idade, diagnóstico da condição debilitante, motivo da consulta, uso continuado de medicamentos, imagens radiográficas e tratamentos odontológicos prestados foram todos coletados e posteriormente submetidos à análise estatística descritiva e inferencial (teste do qui-quadrado) ao nível de significância de 5%. Resultados: Quanto aos tipos de procedimentos odontológicos avaliados no presente estudo, dos 210 pacientes, 24% necessitaram de tratamentos curativos dentários em que a terapia periodontal foi o tipo mais prevalente, enquanto os tratamentos endodônticos tiveram a menor prevalência, representando apenas 4%. Houve alta prevalência de doenças crônicas sistêmicas, acometendo 56% dos casos, cuja faixa etária era superior a 40 anos. Conclusão: Check-ups odontológicos regulares devem ser priorizados em pacientes com necessidades especiais para evitar intervenções mais invasivas como em nosso grupo (AU)

Objective: Patients with special needs are those individuals who need special care for an undetermined period of time or for lifetime. The present study is aimed to address the dental care of special needs patients at a private higher education institute in the city of São Paulo. Material and Methods: A descriptive, retrospective study was performed for analysis of 210 dental records of special needs patients who were treated at the Dental Department for Special Patients of the Cruzeiro do Sul University between 2012 and 2018. Data on gender, age, diagnosis of the debilitating condition, reason of the consultation, continued use of medications, radiographic images and dental treatments provided were all collected before being submitted to descriptive and inferential statistical analysis (chi-square test) at a significance level of 5%. Results: As for the types of dental procedures assessed in the present study, of the 210 patients, 24% needed dental curative treatments in which periodontal therapy was the most prevalent type, whereas endodontic treatments had the lowest prevalence, representing 4% only. There was a high prevalence of chronic systemic diseases, affecting 56% of the dental records, whose age group was above 40 years old. Conclusion: Regular dental check-ups should be prioritized in patients with special needs to avoid more invasive interventions as found in our group (AU)

Impact of the COVID-19 pandemic on the gingival health of children and adolescents with cerebral palsy / Impacto da pandemia do COVID-19 na saúde gengival de crianças e adolescentes com paralisia cerebral

Objective: to evaluate the impact of the COVID-19 pandemic on children and adolescents with cerebral palsy, comparing the gingival condition and the type of dental treatment before and after the interruption of dental care. Material and Methods: the retrospective longitudinal study consisted of 273 participants undergoing Dental Clinic of the AACD (Disabled Child Assistance Association), divided into three groups according to age: Group 1 (G1: 0 to 5 years and 11 months; n=137), Group 2 (G2: 6 to 11 years and 11 months; n=85) and Group 3 (G3: 12 to 17 years and 11 months; n=51). Sociodemographic, data, clinical pattern of cerebral palsy and use of medication were collected, evaluating the gingival condition by the gingival index and the type of dental treatment before the pandemic and during, nine months after the interruption of dental care. Chi-square, Fisher Exact and Kruskal-Wallis (α=5%) tests were used. Results: the groups were homogeneous in terms of sex (p=0.4581), race (p=0.1725), clinical pattern (p=0.3482) and use of antiepileptic drugs (p=0.3509). Regarding the gingival condition, in the period during the pandemic, there was a reduction in the number of participants with Gingival Index scores 0 and 1 and an increase in participants with scores 2 and 3 (p<0.05). As for the procedures performed, the three groups showed a reduction in preventive procedures (p<0.05) and an increase in surgical, periodontal and restorative procedures (p<0.05). Conclusion: it is concluded that the interruption of dental care for nine months during the COVID-19 pandemic in children and adolescents with cerebral palsy had a negative impact on oral health (AU)

Objetivo: avaliar o impacto da pandemia da COVID-19 em crianças e adolescentes com Paralisia Cerebral, comparando a condição gengival e o tipo de tratamento odontológico antes e após a interrupção dos atendimentos odontológicos. Material e Métodos: o estudo longitudinal retrospectivo foi composto por 273 participantes atendidos na Clínica odontológica da AACD (Associação de Assistência à Criança Deficiente), reunidos em três grupos segundo a faixa etária: Grupo 1 (G1: 0 a 5 anos e 11 meses; n=137), Grupo 2 (G2: 6 a 11 anos e 11 meses; n=85) e Grupo 3 (G3: 12 a 17 anos e 11 meses; n=51). Foram coletados dados sociodemográficos, padrão clínico da Paralisia Cerebral e o uso de medicação, avaliando a condição gengival pelo índice gengival e o tipo de tratamento odontológico antes e durante a pandemia, nove meses após a interrupção dos atendimentos. Foram empregados os testes Qui-quadrado, Exato de Fisher e Kruskal-Wallis (α=5%). Resultados: os grupos eram homogêneos quanto ao sexo (p=0,4581), raça (p=0,1725), padrão clínico (p=0,3482) e uso de drogas antiepiléticas (p=0,3509). Com relação à condição gengival, no período Durante Pandemia, observou-se redução no número de participantes com escores Índice Gengival 0 e 1 e aumento de participantes com escores 2 e 3 (p<0,05). Quanto aos procedimentos realizados, os três grupos apresentaram redução de procedimentos preventivos (p<0,05) e aumento dos procedimentos cirúrgicos, periodontal e restaurador (p<0,05). Conclusão: conclui-se que a interrupção do acompanhamento odontológico por nove meses na pandemia da COVID-19 em crianças e adolescentes com PC acarretou impacto negativo na saúde bucal (AU)

Organoleptic Chemical Markers of Serpa PDO Cheese Specificity.

Serpa is a protected designation of origin cheese produced with a vegetable coagulant (Cynara cardunculus L.) and raw ovine milk. Despite the unique sensory profile of raw milk cheeses, numerous parameters influence their sensory properties and safety. To protect the Serpa cheese quality and contribute to unifying their distinctive features, some rheologic and physicochemical parameters of cheeses from four PDO producers, in distinct seasons and with different sensory scores, were monitored. The results suggested a high chemical diversity and variation according to the dairy, month and season, which corroborates the significant heterogeneity. However, a higher incidence of some compounds was found: a group of free amino acids (Glu, Ala, Leu, Val and Phe), lactic and acetic acids, some volatile fatty acids (e.g., iC4, iC5, C6 and C12) and esters (e.g., ethyl butanoate, decanoate and dodecanoate). Through the successive statistical analysis, 13 variables were selected as chemical markers of Serpa cheese specificity: C3, C4, iC5, C12, Tyr, Trp, Ile, 2-undecanone, ethyl isovalerate, moisture content on a fat-free basis, the nitrogen-fractions (maturation index and non-protein and total nitrogen ratio) and G' 1 Hz. These sensory markers' identification will be essential to guide the selection and development of an autochthonous starter culture to improve cheese quality and safety issues and maintain some of the Serpa authenticity.

Effect of High Pressure on the Properties of Chocolate Fillings during Long-Term Storage.

The aim of this study was to evaluate the impact of high-pressure processing (HPP) on the long-term storage of chocolate fillings at room temperature, compared with conventional storage at lower temperatures. Dark chocolate fillings were treated at different pressure levels, holding times and stored at 20 °C for 12 months. Unprocessed batches were stored at 4 °C and at -12 °C. Moisture, water activity (aw), pH, colour, G'1Hz and indigenous microflora were measured at 2, 4, 6, 8, 10 and 12 months of storage. Results showed that 600 MPa/20 min processing was the most effective controlling mesophilic group, presenting 3.8 log cfu/g after 12 months of storage, and inactivating moulds and yeasts after HPP treatment. Colour was affected by storage, including a reduction in the L* parameter in all conditions to final values between 37.8 and 39.3, while the a* parameter increased during storage time at -12 °C and 4 °C to final values of around 12, and parameter b* decreased at storage temperature 20 °C to 5.3. Storage time affected the rheological behaviour of HPP-treated samples, increasing G'1Hz from the 2nd to 12th month of storage time to the final values between 1603 kPa and 2139 kPa. Moisture, aw and pH were not affected by HPP treatment nor storage time.

Temporomandibular disorder in individuals with spinal cord injuries.

OBJECTIVE: This study evaluated Temporomandibular Disorder (TMD) in individuals with Spinal Cord Injuries (SCI) compared to individuals without physical disabilities. DESIGN: Cross-sectional. SETTING: International Fair of Technologies in Rehabilitation and Accessibility (REATECH) and School of Dentistry at the University of São Paulo (USP), Brazil. PARTICIPANTS: In total, 19 patients with SCI and 19 patients without SCI (36.9 ± 11.4 years old) were examined by a calibrated examiner. METHODS: using the following parameters: cervical spine mobility, palpation of muscle groups of the head and neck, functional manipulation of the lateral and medial pterygoids, and joint palpation (Diagnostic Criteria). The pattern and amplitude of mandibular movements were determined during screening using the Helkimo index. STATISTICAL ANALYSES: Student's t-test, chi-square, Fisher's exact and Shapiro-Wilk test were used. RESULTS: The groups did not differ in the presence of noise, pain, temporomandibular joint palpation, locking, dislocation, jaw pain, muscle sensitivity, or in pain, mobility of the cervical spine and functional manipulation. With respect to the jaw mobility index, the groups differed in range of movement (P = 0.020) and maximum right lateral movement (P = 0.007), with the worst values in the SCI group. The groups also differed in relation to lateral flexion in cervical mobility, in which the group without SCI presented better results (P = 0.046). CONCLUSION: The Spinal Cord Injuries group showed higher levels of TMD in terms of range of movement, lateral flexion, and maximum right lateral movement, than the individuals without physical disabilities, demonstrating a clinical significance between cervical and mandibular disability in this group.

Neutrophil extracellular traps (NETs) in patients with STEMI. Association with percutaneous coronary intervention and antithrombotic treatments.

BACKGROUND: Neutrophil extracellular traps (NETs) are formed by DNA, histones and proteolytic enzymes, and are produced by activated neutrophils through different mechanisms. In turn, NETs can activate platelets and coagulation cascade favoring thrombotic processes. The aims of this study were to analyze levels and kinetics of NETs in ST-segment elevation myocardial infarction (STEMI) patients and correlate them with antithrombotic therapy and cardiovascular outcomes at follow-up. METHODS: 150 consecutive STEMI patients referred to primary percutaneous coronary intervention (pPCI) were included. Citrate anticoagulated blood was extracted immediately before pPCI, 30 min and 24 h after the procedure. As markers of NETS cell free DNA (cfDNA), nucleosomes and citrullinated Histone 3 (citH3) were determined. 46 healthy subjects were included as controls. Patients were follow-up for 1.4 ± 0.56 years. RESULTS: Before pPCI, NETs markers were elevated in STEMI patients compared to healthy controls (p < 0.05); these increased significantly 30 min post pPCI (p ≤ 0.001) and decreased at 24 h but remained elevated compared with the control group (p < 0.05). Patients treated with bivalirudin presented a lower increase of NETs 30 min post pPCI compared to patients treated with heparin (p < 0.05). Cardiovascular risk factors or type of stent implanted did not modify NETs levels. Cit3H (HR = 3.74; 95%CI 1.05-13.4; p = 0.042) and left ventricular ejection fraction ≤35% (HR = 6.84; 95%CI 2-23; p = 0.002) were independent predictors of composite endpoint of myocardial infarction, stroke, stent thrombosis and/or cardiovascular-cause death. CONCLUSIONS: NETs were elevated in STEMI patients, increased by pPCI and decreased thereafter. One of the most specific NETs markers was associated with cardiovascular outcomes.

Shprintzen-goldberg craniosynostosis: craniofacial and oral characteristics, diagnosis, and clinical management of a very rare syndrome / Craniossinostose de shprintzen-goldberg: características craniofaciais e orais, diagnóstico e manejo clínico de uma síndrome muito rara

ABSTRACT Shprintzen-Goldberg craniosynostosis syndrome, characterized by craniosynostosis and marfanoid habitus, is a very rare entity described in 75 individuals worldwide. This study aimed to present a case report of a 6-year-old female Brazilian child with Shprintzen-Goldberg's craniosynostosis syndrome. We described the craniofacial and oral characteristics and its clinical management, comparing to the existing literature. The patient presented with intellectual disability, craniosynostosis, ocular proptosis, low-set anomalous ears, and other skeletal and connective tissue defects. Oral features included malocclusion, micrognathia, pseudo-cleft palate, dental caries, and inefficient biofilm control. The treatment started with guidance on cariogenic foods, oral hygiene, and an indication to discontinue bottle feeding. Subsequently, the carious lesions were restored with composite resins, and the patient was referred for orthopedic surgery, orthodontic treatment, speech therapy, and nutritional counseling. The patient was followed for 5 years. This case report emphasizes the importance of knowing the craniofacial and oral characteristics for the diagnosis and clinical management of a female child with a rare Shprintzen-Goldberg's craniosynostosis syndrome. The case also highlights the need for oral health care in individuals with intellectual disabilities.

RESUMO A síndrome Shprintzen-Goldberg é uma entidade muito rara descrita em 75 pessoas, caracterizada por craniossinostose e habitus marfanóide. O objetivo deste estudo é apresentar o relato de um caso clínico de uma criança brasileira de 6 anos com síndrome da craniossinostose de Shprintzen-Goldberg, apresentando as características craniofaciais e orais e seu manejo clínico, comparando com a literatura. O paciente apresentava deficiência intelectual, craniossinostose, proptose ocular, orelhas anômalas de implantação baixa e outros defeitos esqueléticos e do tecido conjuntivo. As características orais incluíram má oclusão, micrognatia, pseudo fenda palatina, atividade de cárie e controle ineficiente do biofilme. O tratamento foi iniciado com orientações sobre alimentos cariogênicos, higiene oral e indicação de suspensão do uso de mamadeira. Em seguida, as lesões cariosas foram restauradas com resina composta e o paciente encaminhado para cirurgia ortopédica, tratamento ortodôntico, fonoaudiologia e nutricionista. O paciente foi acompanhado periodicamente por 5 anos. Este relato de caso enfatiza a importância do conhecimento das características craniofaciais e orais para o diagnóstico e manejo clínico de uma criança do sexo feminino com síndrome de craniossinostose de Shprintzen-Goldberg rara, destacando a necessidade de cuidados com a saúde bucal em indivíduos com deficiência intelectual.

Mandible bone density in adolescents with cerebral palsy using antiepileptic drugs / Densidade óssea da mandíbula em adolescentes com paralisia cerebral em uso de drogas antiepilépticas

Objective: The aim of this study was to assess the bone density of the mandible in adolescents with cerebral palsy (CP) treated with antiepileptic drugs using one beam computed tomography (CBCT). Methods: The study was carried out with 18 adolescents aged 12­18 years, undergoing routine dental treatment at the dental clinic of APCD-São Caetano do Sul. CBCT scans were of divided into two groups: G1 adolescents with CP using antiepileptic drugs and G2 normoactive adolescents. A single dentomaxillofacial radiologist assessed and evaluated the images using Dental Slice software and Image J. Fisher's exact tests as well as paired and unpaired Student's t-tests were performed. Results: Groups differed significantly with regard in the values of density (p < 0.001), with G1 presenting lower values compare to G2. G1 showed significantly lower density means on the right side, left side, and right/left sides of the mandible edge than G2 (p < 0.001). Conclusion: CP patients using antiepileptic drugs show evidence of bone mineral density loss of the mandible.(AU)

Objetivo: O objetivo deste estudo foi avaliar a densidade ótica óssea da mandíbula em adolescentes com paralisia cerebral (PC) tratados com drogas antiepilépticas por meio de tomográfica computadorizada de feixe cônico (TCFC). Métodos: O estudo foi realizado com 18 adolescentes de 12 a 18 anos, em tratamento odontológico de rotina na clínica odontológica da APCD-São Caetano do Sul. As TCFC foram divididas em dois grupos: G1 adolescentes com PC em uso de antiepilépticos e G2 adolescentes normoativos. Um único radiologista dentomaxilofacial assessou e avaliou as imagens usando usando os softwares Dental Slice e Image J. Os testes exatos de Fisher, bem como os testes t de Student pareados e não pareados foram realizados. Resultados: Os grupos diferiram significativamente quanto aos valores de densidade óptica (p <0,001), com o grupo G1 apresentando valores menores em relação ao G2. O grupo G1 apresentou médias de densidade óptica significativamente menores nos lados direito, esquerdo e direito / esquerdo da borda da mandíbula do que o G2 (p <0,001). Conclusão: Pacientes com PC em uso de drogas antiepilépticas apresentam evidências de perda de densidade óssea da mandíbula (AU)

Perfil dos endodontistas de uma metrópole brasileira quanto ao atendimento odontológico a pacientes com necessidades especiais / Profile of endodontists in a Brazilian metropolis regarding dental care for patients with special needs

O objetivo do estudo foi caracterizar o perfil dos endodontistas do estado de São Paulo, Brasil em relação ao tratamento odontológico depacientes com necessidades especiais (PNE). Um questionário onlinesobre capacitação do profissional e dados sobre o atendimento odontológico de PNEfoi enviado para 3.500 endodontistas registrados no Conselho Regional de Odontologia de São Paulo. Dentre os 138 profissionais que retornaram, 57,2% eram do sexo feminino; 34,8% estavam na faixa etária entre 31e 40 anos; 42,8% tinham entre 11 e20 anos de formados; e 38,4% possuíam 11 a 20 anos de especialidade. Apenas 22,5% eram capacitados para o atendimento de PNE, sendo que desses, 58,1% tiveram apenas aula teórica. Dos que não receberam capacitação na pós-graduação, 80,4% gostariam de ter recebido. Com relação ao interesse em cursos de atendimento a PNE após a especialização, observou-se que apenas 15,9% realizaram algum tipo de curso, a maioria apenas teórico. Em relação às dificuldades durante o atendimento de PNEa "falta de colaboração do paciente durante o atendimento" foi citada por 74,6%, a "insegurança devido àfalta de preparo profissional" por 55,0%. A análise da associação das variáveis pelo teste Qui-quadrado apontou que quanto maior o tempo de formação, menor essa dificuldade (p=0,0415). Os especialistas encontram mais dificuldades comparados aos que tem formação associada (mestrado e doutorado) (p=0,0369). Não houve associação significativa entre as dificuldades e o tipo de instituição de formação(pública ou privada) (p>0,05). O panorama atual da formação do endodontista não contempla o atendimento as pessoas com necessidades especiais (AU).

The aim of this study was to characterize the profile of endodontic professionals from the state of São Paulo, Brazil in relation to dental treatment for patients with special needs (PSN). An online questionnaire on professional training and data on PSN dental care was sent to 3,500 endodontic professionals registered with the São Paulo Regional Dental Council in 2017. Of the 138 returning professionals, 57.2% were female; 34.8% aged 31-40 years; 42.8% had 11-20 years since graduation; 38.4% had 11-20 years of endodontic specialization. Only 22.5% were trained to provide dental care to PSNs and of these, 58.1% had only theoretical classes. Of those who did not receive post-graduation training, 80.4% would like to have received it. Regarding the interest in PSN care courses after specialization, it was observed that only 15.9% performed some type of course, most of them theoretical only. Regarding difficulties during PSN care, "lack of patient collaboration during care" was mentioned by 74.6%, and "insecurity due to lack of professional preparation" by 55.0%. The analysis of the association of variables by the Chi-square test showed that the longer the training time, the lower the difficulty during PSN care (p=0.0415). Specialists find more difficulties compared to those with associated training (masters and doctorate) (p=0.0369). There was no significant association between difficulties in PSN care and typeof HEI (public or private) (p> 0.05). The current panorama of endodontic professional training does not seem to include care for patients with special needs (AU).

Impact of environmental conditions on the ripening of Queijo de Évora PDO cheese.

"Queijo de Évora" is a traditional Portuguese cheese from raw ewe's milk and granted with PDO label. It is ripened traditionally in rooms with empirical control of temperature and humidity. Nowadays, almost all cheese factories use rooms with temperature and humidity control, but still a significant heterogeneity among cheeses is acknowledged due to unequal distribution of environmental conditions. This paper discusses the influence of the environmental conditions on the ripening of Queijo de Évora, including the application of computational fluid dynamics in steady state conditions. Experimental data was obtained in cheeses ripened along the traditional ripening cycle, in different locations. A significant influence of environmental conditions was observed, especially air velocity and humidity, affecting physical-chemical, microbiological and sensory characteristics. Locations with higher air velocity, presented cheeses with lower moisture content, higher mesophilic bacteria count, darker appearance and higher number of holes. Locations with higher humidity presented cheeses with lower scores on some sensorial parameters like appearance, firmness and intensity of odor. The results of computational fluid dynamics made possible the identification of areas in and around the cheese stacks were the air distribution is less than adequate or uneven, which may influence the evolution of cheese during ripening.

Applying Computational Fluid Dynamics in the Development of Smart Ripening Rooms for Traditional Cheeses.

Traditional ewe's cheese producers face certain challenges caused by fluctuating environmental parameters inside the ripening room, which lead to lack of homogeneity in the final product. The present research discusses the application of computer fluid dynamics for simulating the distribution of environmental parameters, predicting the airflow pattern, and identifying critical areas where such parameters could cause reduced cheese quality. A new monitoring system was developed including presence sensors, temperature and humidity dataloggers, pneumatic actuators, microcontrollers, and microcomputers connected remotely for control, data visualization, and processing. The validation of the computer simulation and monitoring system was made with a batch of 40 ewe's cheeses distributed in three different zones inside a prototype ripening room and ripened for 35 days. At 35 days, a physical, chemical, and microbiological characterization of cheeses was made for evaluation of the influence of environmental conditions on cheese quality. The comparison between simulated and local measurements showed close agreement, especially concerning air velocity inside the stacks of cheese. The results of Pearson's correlation analysis and PCA concluded that temperature affected the appearance of the rind, hardness, number and area occupied by holes. Humidity affected aw and mFeret. Air velocity affected pH and the circularity of gas holes.

Caries prevalence using ICDAS visual criteria and risk assessment in children and adolescents with cerebral palsy: A comparative study.

AIMS: To compare the dental caries prevalence using the International Caries Detection and Assessment System (ICDAS) and the caries risk by Caries Management by Risk Assessment (CAMBRA) in individuals with cerebral palsy (CP) and normoactives (NAs). METHODS AND RESULTS: Sixty children and adolescents aged 6-12 years (30 CP/30 NA) were clinically evaluated by one calibrated examiner using two-digit ICDAS criteria and converted into components of dmf/DMF indices: d2mf2/D2MF2 (enamel and dentin lesions) and d3mf3/D3MF3 (dentin lesions). An adapted CAMBRA was used for risk classification. The mean d2mf2s/d2mf2t and D2MF2S/D2MF2T for CP were 17.0 ± 16.8/7.5 ± 4.3 and 10.7 ± 17.6/5.3 ± 5.8, respectively, and for NA were 17.2 ± 16.9 /6.9 ± 4.8 and 11.1 ± 11.7/5.5 ± 4.7, respectively. The mean d3mf3s/d3mf3t and D3MF3S/D3MF3T for CP were 10.1 ± 16.7/3.0 ± 4.1 and 4.9 ± 15.6/0.2 ± 0.4, respectively, while for NA the mean values were 9.8 ± 13.0/3.5 ± 3.8 and 2.1 ± 5.7/0.9 ± 2.0, respectively. There were no statistically differences for caries prevalence and risk in both groups (p > 0.05). CONCLUSIONS: Dental caries was highly prevalent in CP and NA children and adolescents. Enamel and dentin lesions and high caries risk were the most common condition.

The Impact of Oral-Gut Inflammation in Cerebral Palsy.

Background: Oral-gut inflammation has an impact on overall health, placing subjects at risk to acquire chronic conditions and infections. Due to neuromotor disturbances, and medication intake, cerebral palsy (CP) subjects present intestinal constipation, impacting their quality of life (QOL). We aimed to investigate how oral inflammatory levels predicted gut phenotypes and response to therapy. Methods: A total of 93 subjects aging from 5 to 17 years were included in the study, and assigned into one of the 4 groups: CP with constipation (G1, n = 30), CP without constipation (G2, n = 33), and controls without CP with constipation (G3, n = 07) and without CP and without constipation (G4, n = 23). In addition to characterizing subjects' clinical demographics, medication intake, disease severity levels, salivary cytokine levels [TNF-α, interleukin (IL)-1ß, IL-6, IL-8, IL-10], and Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD). Statistical significance was evaluated by Shapiro-Wilks, Student's T-Test, ANOVA, and ANCOVA analysis. Results: Salivary proinflammatory cytokines were highly correlated with the severe form of gut constipation in G1 (P < 0.001), and out of all cytokines IL-1ß levels demonstrated highest correlation with all gut constipation (P < 0.05). A significant relationship was found between the type of medication, in which subjects taking Gamma-Aminobutyric Acid (GABA) and GABA+ (GABA in association with other medication) were more likely to be constipated than the other groups (P < 0.01). Cleary salivary inflammatory levels and gut constipation were correlated, and impacted QOL of CP subjects. G1 presented a lower QOL mean score of CPCHILD (49.0 ± 13.1) compared to G2 (71.5 ± 16.7), when compared to G3 (88.9 ± 7.5), and G4 (95.5 ± 5.0) (P < 0.01). We accounted for gingival bleeding as a cofounder of oral inflammation, and here were no differences among groups regarding gender (P = 0.332) and age (P = 0.292). Conclusions: Collectively, the results suggest that saliva inflammatory levels were linked to gut constipation, and that the clinical impact of medications that controlled gut was reliably monitored via oral cytokine levels, providing reliable and non-invasive information in precision diagnostics.

Epidemiological profile of patients with disabilities undergoing dental treatment under general anesthesia / Perfil epidemiológico de pacientes com deficiência submetidos a tratamento odontológico sob anestesia geral

Introduction General anesthesia is commonly used in the dental treatment of people with disabilities, anxious or difficult behavior, who need complex and/or extensive treatments. Objective The aim of this study was to evaluate the epidemiological profile of patients with disabilities undergoing dental treatment under general anesthesia by the team of the Dental Unit for Patients with Special Needs of the Federal University of Sergipe. Material and method Through the analysis of 371 dental records of patients assisted between August 2002 and March 2019. Result The analysis showed that 56.1% of patients were male, the most prevalent age group was 11-20 years, and the most frequent medical conditions were intellectual disability, followed by multiple disabilities. Relative to dental procedures, in 94.1% of the patients, it was observed that 4,056 dental extractions were performed and in 52.3% of patients, 1,156 restorations were performed. In 30.2% of patients, total multiple extractions were performed. Radiographic examination was performed in 51.8% of patients. As regards the origin of patients, 58.8% were from municipalities in the state, other than the capital. Return to the service for follow-up and prevention was observed in 38.5% of patients. Conclusion There is great need for early dental intervention, with specific preventive actions for this group of patients, focusing on those from interior regions of the state.

Introdução A anestesia geral é comumente utilizada no tratamento odontológico de pessoas com deficiência, ansiosos ou com difícil comportamento, que necessitem de tratamentos complexos e/ou extensos. Objetivo Avaliar o perfil epidemiológico da pessoa com deficiência submetida a tratamento odontológico sob anestesia geral pela equipe da Unidade de Odontologia para Pacientes com Necessidades Especiais da Universidade Federal de Sergipe. Material e método Através da análise de 371 prontuários de pacientes assistidos entre agosto de 2002 e março de 2019. Resultado Observou-se que 56,1% dos pacientes eram do sexo masculino, que a faixa etária mais prevalente foi de 11-20 anos de idade e que as condições médicas mais frequentes foram a deficiência intelectual, seguida pelas múltiplas deficiências. Quanto aos procedimentos odontológicos, observou-se que em 94,1% dos pacientes foram realizadas 4.056 extrações dentárias e em 52,3% dos pacientes 1.156 restaurações. Em 30,2% dos pacientes foram realizadas extrações múltiplas totais. O exame radiográfico foi realizado em 51,8% dos pacientes. Em relação a procedência dos pacientes, 58,8% eram provenientes de outros municípios do estado, distinto da capital. Os retornos ao serviço para acompanhamento e prevenção foi observado em 38,5% dos pacientes. Conclusão Há uma grande necessidade de intervenção precoce da odontologia, com ações preventivas específicas para esse grupo de pacientes, com enfoque no interior do estado de Sergipe.

Comparison of salivary cytokines levels among individuals with Down syndrome, cerebral palsy and normoactive.

BACKGROUND: Individuals with Down syndrome (DS) present increased susceptibility to infections and high prevalence of periodontal disease. The objective of this study is to evaluate the salivary concentrations of IL-1ß, IL-6, IL-8, IL-10, TNFα and IL-12p70 of DS individuals and compare to cerebral palsy (CP) and normoactive patients (all with gingivitis). MATERIAL AND METHODS: Twenty-two individuals with DS, 24 with CP and 22 normoactive participated in this cross-sectional study. Salivary flow rate, osmolality rate, Oral Hygiene Index, Gingival Index (GI) and salivary inflammatory markers IL-1ß, IL-6, IL-8, IL-10, TNFα and IL-12p70 were evaluated. Shapiro-Wilks, Chi-square, ANOVA One-Way and Kruskal Wallis tests were applied with significance level at 5%. RESULTS: The groups were homogenous for gender, age, and IL12p70 cytokine (p>0.05). GI was significantly higher in DS compared to CP and healthy (p<0.05). CP presented reduced salivary flow and increased osmolality rate. CP showed significantly higher values for TNFα, IL10, and IL6 compared to DS and normoactive (p<0.05). DS and CP presented significantly higher values of IL-1ß and IL8 compared to normoactive (p<0.05). CONCLUSIONS: Individuals with CP have higher risk to develop periodontal disease due to reduced salivary flow rate, increased salivary osmolality rate and elevated TNFα, IL-10, IL-6 compared to DS. Key words:Cytokines, biomarkers, gingivitis, periodontal diseases, Down syndrome, cerebral palsy, saliva.

Morphology, Volume, and Density Characteristics of the Parotid Glands before and after Chemoradiation Therapy in Patients with Head and Neck Tumors.

The multimodal approach for patients with head and neck cancer (HNC) includes treatment with chemoradiation therapy (CRT). A common concern regarding CRT side effects is the occurrence of structural and physiological alterations of the salivary glands due to exposure to ionizing radiation. The aim of this study is to examine the morphology, volume, and density of the parotid glands before and after CRT in HNC patients. A total of 49 HNC patients treated exclusively with CRT were included in the study. Ninety-eight parotid glands were evaluated before and after treatment by using contrast-enhanced computed tomography (CECT). Shapiro-Wilk test was performed, and the variables (pre-CRT and post-CRT) presented normal distribution. Pearson's coefficient was used to assess the correlation between volume and density. CRT resulted in a significant decrease in the mean volume of the parotid glands (i.e., original volume reduced by 20.5%; P < 0.0001). CRT induced a 30.0% (7 Hounsfield units) increase in density of the right parotid gland and a 24.9% (8 Hounsfield units) increase in density of the left parotid gland (P=0.0198 and P=0.0079, respectively). Changes in morphology and spatial configuration, increased density, and substantial loss of volume of the parotid glands were observed after CRT. There was also a difference in density (P=0.003) in the right-side parotid glands in comparison between xerostomic and nonxerostomic groups of patients. These facts lead to the need for a personalized CRT planning in order to minimize oral complications related to the treatment.

Assessing Student Competencies in Antibiotic Stewardship and Patient Counseling.

BACKGROUND AND OBJECTIVES: Antibiotic misuse contributes to antibiotic resistance and is a growing public health threat in the United States and globally. Professional medical societies promote antibiotic stewardship education for medical students, ideally before inappropriate practice habits form. To our knowledge, no tools exist to assess medical student competency in antibiotic stewardship and the communication skills necessary to engage patients in this endeavor. The aim of this study was to develop a novel instrument to measure medical students' communication skills and competency in antibiotic stewardship and patient counseling. METHODS: We created and pilot tested a novel instrument to assess student competencies in contextual knowledge and communication skills about antibiotic stewardship with standardized patients (SP). Students from two institutions (N=178; Albert Einstein College of Medicine and Warren Alpert Medical School of Brown University) participated in an observed, structured clinical encounter during which SPs trained in the use of the instrument assessed student performance using the novel instrument. RESULTS: In ranking examinee instrument scores, Cronbach α was 0.64 (95% CI: 0.53 to 0.74) at Einstein and 0.71 (95% CI: 0.60 to 0.79) at Brown, both within a commonly accepted range for estimating reliability. Global ratings and instrument scores were positively correlated (r=0.52, F [3, 174]=30.71, P<.001), providing evidence of concurrent validity. CONCLUSIONS: Similar results at both schools supported external validity. The instrument performed reliably at both institutions under different examination conditions, providing evidence for the validity and utility of this instrument in assessing medical students' skills related to antibiotic stewardship.

Tooth avulsion accidents due to urgent and emergency orotracheal intubation

BACKGROUND: Intubation is necessary during critical situations to reduce the risk of death. In Brazil, a need exists to determine the prevalence of tooth avulsions in emergency and urgent care. The objective of this study was to identify the causes of orotracheal intubation (OTI), the number of tooth avulsions, and the avulsed teeth that result from urgent and emergency intubation. MATERIAL AND METHODS: The sample consisted of 116 patients (total group) in intensive care units (ICUs) distributed across Group 1 (G1), which was composed of 71 patients from an urgent-care hospital, and Group 2 (G2), which was composed of 45 patients from an emergency hospital. Clinical examinations showed dental alveolus with signs of recent exodontia in the upper and lower anterior regions. Sociodemographic data and the reason for intubation were evaluated. The Shapiro-Wilk normality test, chi-square test, Fisher's exact test, Mann-Whitney U test, and univariate logistic regression were performed with a significance level of 5%. RESULTS: The avulsion prevalence was 4.3%, with more cases receiving emergency intubation (n = 4). All avulsions occurred in adults, and a significant difference (p = 0.011) was observed with regard to the elderly. A 1-year reduction in age increased the chance of tooth avulsion during intubation by 1.09 times; being female increased the chance by 2.88 times. CONCLUSION: Pulmonary problems were the major causes of intubation, with the highest tooth avulsion prevalence observed during emergency intubation. The avulsed teeth were 11, 12, 13, 22, 32, and 33 across all cases

No disponible